ltJErasmus+

I confirm dI have
• ) been informed of all the louistical
o· aspects (trave1 arrangements meals
accommo ation and financial aspects regarding reimbursement of costs. ' '
Inh ·1d
case. of an emergency
d situation, I agree to any emergency treatment to be given to my
c I ' m accor ance to the laws in the host country.

I acknowledge the need for my child to behave responsibly at all times.

Personal information on the child:
Details on medical conditions, allergies, phobias, disabilities: ..~ / ? /;i,/41f
Details on any medication: .... ............ .

Dietary requirements·............. ···························

Any other useful information·.......................

/t{)~

Parent or guardian contact details during travel and stay abroad:

Phone number: land line .................................. ; mobile: .:tJ!fd.f[.f/t3.(J&v.l/l
In case I am not available, the organizers can also contact:

Name of second contact person: ~/J0 ./i:- t}tt-doff

Phone number: land line .................................. ; mobile: ...t.J.t/-t.i:ifd.ff.-2.:?fl

r
Signature of the parent/ guardian Date: I?tP/.~,:;(1/

Photo/video consent
I give permission to the organizers to take photographs/ videos of my child.

I give permission to the organizers to use the photographs and videos taken in order to
promote the project and its results, which may include, among others, publishing them
on social media accounts, on websites of involved organizations, in mass-media, in
leaflets/other promotional materials etc.

Signature of the parent/ guardian

All personal data contained in this document are collected during the implementation of the Erasmus +
Programme (2014-2020), in accordance with the European Commission regulations. The data will be
stored and processed by the Programme's beneficiary organisations and the ANPCDEFP under the
2
 To whom it may concern (Koigile asjassepuutuvatele),

I/we (Mina/meie), _ _ _ _ _ .O
i.;:--te-7.'-j~j~-=----~~ ~~--- e..::.......:.~..:::.!,!:.:::...__ _ _ _ _ _ _ _ __
U fullname (tliisnimi)
b---"-"-=-"--"c-=-"'--'---'N.A/
Address (Elukoha aadress): _ _ (w ~--+/4: --='----t;
~f__________

am/ are the custodial parent(s) or guardian of the following child (olen/oleme alljiirgneva lapse
hooldusoigusega vanem(ad) voi eestkostja :

Child's full name (Lapse taisnimi): /4£;Iv JJufl.,;t,~

Date and place of birth (Sunniaegja-koht): _c_~~ t --=-OL.:.
l '---"'O=li_ __,,~"'-'£=HJ,
:..=.:...w~ tv
--+-
, _,Tati'l
___."""""''-'L-L-~-=-h
--=-----
/

Number of Passport/ID card (Passi/ID-kaardi number): _-'~

'--'----=~-()GJ
-==~:...=...~5i_G_______

This child has my / our consent to travel alone or to travel with (Nimetatud lapse/ on minulmeie
nousolek reisida uksi voi koos alljiirgneva isikuga):

Full name of accompanying person (Saatja tiiisnimi): _,rl.!!_!el~en~a~Fw.i~od~o~ro~v~a'---_ _ _ _ _ _ __

Relationship to child (Suhe lapsega):....!P...!cro~~~ece..!:.t~lee!:!a~de~r_ _ _ _ _ _ _ _ _ _ _ _ _ _ __

mother (ema)Jather (isa), grandparent (vanavanem), sister (ode),
brother (vend), relative (sugulane)Jriend (sober), other (muu)

Number of Passport/ ID card (Passi I ID-kaardi number): ...!.A~C~0!.L9~04~0~0'...!._7_ _ _ _ _ _ _ _ __

I/ We give our consent for this child to travel to (Annanlanname nousoleku oma lapsele
reisimiseks):

Name of the destination country/ countries (Sihtriikl-riigid):-'R~o""m~aru=

·a,___ _ _ _ _ _ __

Travel dates (Reisi kuupiievad): ..l:.2c1:1-~2.z9.~0z,9.,b.20~2:,:2,___ _ _ _ _ _ _ _ _ _ _ _ _ _ __

Signature(s) of person(s) giving consent (Nousoleku andva(te) isiku(te) al/kiri):

11: 0/. tld.,,,

date (kuupliev)

I
. lilerasmus+

Parental/Guardian consent

I, undersigned, C!f..'if!r..... #..~i?:,0&.. ............,

..... yarent/guardian of the
chi~/young _person l i._.,6.r.r::... &~~orn on t.ll.qtl..JJ.f).~.._. ... , of nationality
....c;..{!.. ,/;.Q(.l!..(k.l'Jt:..... , give consent for my child to take part m the activity:

Name of activity: Youth exchange

Funded by the European Union under the Erasmus+ project: Street Art Club

Coordinating organization: Asociatia "Go for it"

Sending organization: MTU Kunda Sotsiaal-ja Tervisekeskus

Host organization: Asociatia "Go for it"

Period of the youth exchange: 22-28 September 2022

Travel days: 21th and 29st of September 2022

Location: Galati/Romania
Accommodation at: City Break Hotel, Galati, Romania
Contact details of the group leader accompanying the child that I can contact
at any time: Jelena Fjodorova, +372 53607109, jelenafjodorova78@gmail.com (name,
telephone number, email address)
Contact details of the project coordinator: Laurentiu Petrea, +40 (767)766819,
laurpetrea@gmail.com (name, telephone number, email address)

Activities taking place at: City Break Hotel, Galati, Romania.

Description of the activities and methods used during the youth exchange: Non formal,
Study visits and Graffiti workshops.
I confirm that I have been informed by the project organizers of the activities my child
will take part in, as well as of the learning methods that will be used. I confirm I have
received a copy of the daily programme of activities.
I agree for my child to take part in all the proposed activities.

1
 STATEMENT
1
I, ... J.f.4./l:,. .d~d'~. . . . . . . . . . . . . . . ~ confirm my

participation in the Erasmus+ youth exchange project "Street Art Club" in

Galati, Romania (22-28.09.2022). My non-participation is justified only in

case of force majeure*. If tickets have been purchased i

decide not to come to the project (which i!,Qt due

pay for the ticket name change (if pos~ e) or the

, 20 euros is added.

*Force majeure - an unforeseeable circumstancu h) ~ does not depen

concluding the agreement, which could not be influenced or prevented

does not allow the fulfillment of obligations un

certificate is required as proof.

Date and participant's signature (if under the

also required): "'
~f!!r.l~ . . . . . . . . . .... . . . . .(7.t.?.(&.:~.......... ...
YI/Pf t!f
MTU KUNDA SOTSIAAL· JA TERVISEKESKUS
NGO KUNDA SOCIAL AND HEALTH CENTER
ORGANISATION REGISTRATION NUMBER: 80311990
ADDRESS: ESTONIA, KUNDA, EHITAJATE 8, 44107
PHONE NUMBER: +372 53607109, +372 53853587 PIOjKt Is lmplemeftted wllll llnlnclll support ol tlla
lla-Commb&IINI l11lhl lm-PralJlnvnt,
ORGANISATION: NON-GOVERNMENTAL